Malabsorption and autoimmune disorders

I was diagnosed with pernicious anemia last year, a late diagnosis given that I had an incomplete spinal cord injury and did not attach much significance to early symptoms.  I started B12 loading doses but after two complete cycles (daily/weekly/monthly) I still haven't been able to get my serum B12 much above 400, so my GP has put me on weekly injections this month for an indefinite period of time.  I haven't seen any real improvement in my symptoms, either, but I understand that late diagnosis make make those changes irreversible (I have a pacemaker so an MRI is not possible, but my neurologist believes an MRI would show lesions).  My symptoms include numbness, tingling, spasticity, urinary retention, tachycardia, tinnitus, memory and balance problems (abnormal ENG indicating central or bilateral peripheral vestibulopathy).  I was also diagnosed with autonomic failure many years ago and I understand that all these diagnoses share symptoms so it is hard to pinpoint what is causing which.  In my most recent bloodwork, my GP discovered that my IgA was less than 4 and my IgM is 549 (I am female).  My hemoglobin is normal, ferritin 8, MCV normal but RDW elevated.  Can this be an indicator of a malabsorption disorder that is affecting my retention of B12?  I've always thought I had a strong immune system so I'm not sure what to make of this.  Is there anything else that should be checked?  Thanks very much.

[Kevin Pho, MD]

Difficult to say.  Other possible causes can include H Pylori, malabsorption syndromes, inflammatory bowel diseases and hereditary causes.

You can test for various malabsorption disorders with blood tests looking for celiac disease, or analyzing the stool looking for fat malabsorption.  An IgA endomysial antibody would need to be done to look for celiac disease.

A referral to an immunologist can be considered to look at the test results you obtained.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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